Progesterone begins to decline naturally after the age of 30 due to aging—this is purely biological and inevitable. Unlike other hormones that can be influenced by lifestyle factors, nothing can stop this decline—not lowering stress, not taking supplements, and not even high-protein diets. The reality is that the ovaries are aging, leading to a progressive drop in progesterone levels (and estradiol) which has widespread effects throughout the body. For decades, progesterone was thought to be only necessary for pregnancy, leading to the widespread belief that it had little role outside of fertility and gestation. Many women who have had a hysterectomy are not prescribed progesterone under the assumption that they no longer need it. This outdated view has misled countless women, depriving them of one of the most critical hormones for overall health.
Progesterone is, in fact, the most abundant hormone in women, playing essential roles in brain function, mood regulation, sleep, metabolic balance, and cardiovascular health. It is far more than just a reproductive hormone—its influence extends across nearly every system in the body. As research evolves, it has become increasingly clear that progesterone therapy is a crucial tool in managing perimenopausal and menopausal symptoms and supporting long-term well-being. Among all forms of progesterone, bioidentical micronized progesterone has been shown to be the safest and most effective therapy.
Low Progesterone in Perimenopause and Menopause: Symptoms
As women approach perimenopause, progesterone levels begin to decline rapidly. Normal progesterone levels should be at least 3,000 pg/mL (3 ng/dL) and can be variable with a wide range of normal (up to 20,000 pg/mL, or 20 ng/dL). Often during this time, they are 500 pg/mL (0.5 ng/dL) or less! Women are frequently told that this is “normal.” This leads to suffering for years without help and progesterone deficiency is responsible for some of the most universal and common symptoms including:
- Anxiety and Depression: Low progesterone can result in increased anxiety, irritability and depression. Progesterone has calming effects on the brain, promoting GABA activity, which helps reduce anxiety and improve mood.
- Insomnia: Sleep disturbances are common due to declining progesterone levels. Studies show that micronized progesterone improves sleep quality and reduces nighttime awakenings.
- Heavy Menstrual Bleeding: Without sufficient progesterone the uterine lining goes unregulated leading to heavy or prolonged menstrual bleeding. Progesterone therapy can help regulate cycles and reduce excessive bleeding.
- Dry Skin and Hair: Progesterone plays a vital role in maintaining skin hydration and elasticity. A decline in progesterone levels can contribute to dry skin and thinning hair.
- Vaginal Dryness: Low progesterone levels are linked to decreased vaginal moisture, leading to discomfort, irritation, and pain during intercourse.
- Eczema and Itchy Ears: Hormonal imbalances, particularly low progesterone, can trigger inflammatory responses that exacerbate conditions such as eczema and itchy ears.
- Food Insensitivities and Autoimmunity: Progesterone helps regulate immune function, and its decline can contribute to an increased likelihood of food sensitivities and autoimmune conditions such as Hashimoto’s thyroiditis.
The Best Way to Take Progesterone: Why Vaginal is Better
One of the most effective ways to take progesterone is vaginally. Progesterone is a large molecule that does not easily penetrate the skin, making transdermal creams less effective. Vaginal administration ensures direct absorption into the bloodstream without the need to pass through the liver.
- Avoiding First-Pass Metabolism: Oral progesterone must pass through the liver before entering circulation, which can result in a significant portion of the dose being metabolized before it reaches target tissues. This process reduces efficacy and increases the likelihood of unwanted side effects such as drowsiness.
- Better Absorption: Vaginal progesterone provides superior absorption and higher bioavailability compared to oral forms, ensuring that lower doses can be used effectively.
- Targeted Benefits: Women experiencing vaginal dryness or local discomfort may benefit from vaginal progesterone creams, as they offer direct relief while also balancing systemic progesterone levels.
“North American Menopause Society Position Statement 2022:
vaginal progesterone is a treatment option that can be used to address (peri)menopausal symptoms, particularly when combined with estrogen therapy, as it helps prevent endometrial overgrowth and the associated risk of endometrial cancer by counteracting the estrogen’s effect on the uterine lining.”
Autoimmunity and Progesterone
During pregnancy, many women with autoimmune conditions experience a significant reduction or even complete remission of symptoms. This phenomenon is largely attributed to the dramatic increase in progesterone levels, which exert powerful immunomodulatory effects.
Progesterone helps shift the immune system from a pro-inflammatory Th1-dominant state to an anti-inflammatory Th2-dominant state, reducing the hyperactive immune responses that drive autoimmune diseases.
Studies have shown that conditions such as rheumatoid arthritis, multiple sclerosis, and Hashimoto’s thyroiditis often improve during pregnancy due to this immune shift. Additionally, progesterone enhances regulatory T-cell (Treg) activity, which plays a crucial role in maintaining immune tolerance and preventing the immune system from attacking the body’s own tissues
This temporary relief highlights progesterone’s profound impact on immune function and suggests that progesterone therapy may be a valuable tool in managing autoimmunity outside of pregnancy.
The Inner Balance Approach: Personalized Hormone Optimization
At Inner Balance, we prioritize safe, effective, and individualized hormone therapy. Our focus on bioidentical micronized vaginal progesterone ensures that women receive the highest quality care tailored to their needs.
Progesterone, as the most abundant hormone in women, should not be ignored in perimenopause or after a hysterectomy. By addressing hormone imbalances and deficiencies early, we can prevent long-term health complications and improve overall well-being. If you are experiencing anxiety, depression, insomnia, heavy menstrual bleeding, vaginal dryness, dry skin and hair, eczema, itchy ears, or other perimenopausal symptoms, consider progesterone therapy as part of your holistic approach to health.
